Maternal depression is prevalent among low-income minority women and is associated with increased use of problem-oriented child health care services including sick-child visits, emergency department (ED) visits, and hospitalizations. A variety of mechanisms to explain these associations have been suggested, but few have been empirically tested. The overall goal of this research is to improve the understanding of how maternal depression impacts child health care use by examining potential mediating mechanisms. The investigation of the association between these mechanisms and child health care use will provide insights into strategies for developing more targeted interventions. The first specific aim is to determine if two mechanisms (self-efficacy and maternal-child interactions) are mediators between depressive symptoms and problem-oriented child health care use. Self-efficacy is the belief that one can be effective at a certain task. Mother-child interactions describe how well the mother and child communicate with each other through sending, receiving, and reacting to cues. The second specific aim is to explore how patterns of child health care use are impacted by maternal depression, focusing on three separate aspects: ambulatory care sensitive conditions (expected to increase with depressive symptoms), ED visits as a substitute for primary care, and well-child visits (expected to decrease with depressive symptoms). The existing evidence for ambulatory care sensitive conditions has not been replicated and the evidence for well-child visits is inconsistent. ED visits have not been tested as a substitute for primary care. The planned methods for testing the above relationships are linear and negative binomial regression, except for utilization of well-child visits which will use ordered logit regression. The relationships of depression and self-efficacy with health care use will be allowed to be non-linear, possibly quadratic. Model specification tests will confirm if the planned methods and functional forms are appropriate. ED visits and hospitalizations will be classified as ambulatory care sensitive or not using diagnoses in the medical records. All analyses will be risk adjusted for children's chronic conditions and birth weight. Common demographic variables will be used to control for other factors that may contribute to health care use. Data from the control subjects of the Nurse-Family Partnership trial in Memphis, TN will be used (n=460). Mothers were interviewed during pregnancy and at the child's ages of 36 weeks, 6 months, 12 months, and 24 months. Medical records for the children were obtained up to 24 months. If self-efficacy and/or mother-child interactions are found to be important contributors to child health care use, appropriate interventions will need to address these conditions in addition to depression to substantially impact utilization. Fortunately, interventions have been successful at improving both self-efficacy and mother-child interactions. A successful intervention would focus on decreasing the need for additional discretionary visits, without discouraging appropriate visits. Patterns uncovered by the second specific aim may inform policy decisions and future research hypotheses. [unreadable] [unreadable] Public Health Relevance: This study seeks to understand how maternal depression increases the number of sick-child visits, emergency department visits, and hospitalizations for children of depressed mothers. Understanding the specific mechanisms that explain these associations will allow for more successful interventions to be designed, resulting in more efficient use of health care resources as well as healthier families. [unreadable] [unreadable] [unreadable]